BMI - higher BMI - higher doses
age - liver and kidney function could be immature or impaired
gender - females have increased body fat, leading to
... [Show More] changes in medication
absorbtion
med tolerance - could come from long term use, or IV drug use.
med accumulation - results in decrease renal function, therefore
excretion/absorption
psychological factors - the placebo effect
inadequate gastric function - decreased GI absorption, diarrhea
vascular insufficiency - arterial insufficiency, med doesn't get where it needs to go.
liver/kidney disease - reduces medication metabolism
pediatric dosing - bsa or weight based
geriatric dosing - Increased gastric pH, Decreased GI motility, Decreased protein
binding sites, Impaired memory
, Changes in vision and hearing, Polypharmacy
interventions for geriatric patients - Clear and concise instructions, verbally and in
writing. Help the patient set up a daily calendar. Pill containers.
pregnancy concerns with med therapy - Most meds should be considered harmful
don't just assume, talk to doctor
Avoid live virus vaccines: MMR, polio, but inactive flu vaccine is recommended.
Benzodiazepines - -pams + chlordiazepoxide. Treats Anxiety, seizures, muscle
spasms, alcohol withdrawal, induce or maintain anesthesia
Buspirone - Anxiety, PTSD, panic, OCDBenzos pharmacodynamics - Increase the effects of GABA, GABA reduces the
activity of neurons. Side effects: Sedation, amnesia, dependency, withdrawal. Do
not abruptly discontinue.
Flumazenil: antidote!
Buspirone pharmacodynamics - SE: GI upset, dizziness, headache, nausea. Can be
used long term, Sedation not a problem, Number of weeks for effects to be felt
Eat food with them if GI upset.
SSRI's - -ine
treats Anxiety, depression, OCD, PTSD
SSRI pharmacodynamics - How you ask? Inhibit serotonin reuptake
SE: Nausea, wgt gain, fatigue, decreased sexual function. Insomnia for paroxetine
Serotonin syndrome: Agitation, tremors, diaphoresis, fever
Buproprion (Wellbutrin, Zyban) - antidepressant, helps quit smoking
Buproprion pharmacodynamics - SE: Insomnia, weight loss, GI distress
Trazadone: Sedation
Trycyclic antidepressants - - Imipramine, amitriptyline
- Blocks reuptake of Serotonin & norepinephrine
- But also blocks other NTs postsynaptically (Ach, EPI)
Depression, insomnia, fibromyalgia, neuropathy
MAOIs - Phenelzine - for yo depression
Trycyclics pharmacodynamics - Anticholinergic SE: Urinary retention,
constipation, blurry vision, photophobia, dry mouth, tachycardia. Sedation,
sweating, seizures.
Chew gum, wear sunglasses, drink lots of fluids, high fiber diet. Most serious
anticholinergic SE: URINARY RETENTION
MAOI - Pharmacodynamics - SE: HTN crisis, agitation, anxiety, orthostatic
hypotensionInteract with almost everything. Eat foods with tyramine (Salami, aged cheese,
avocado, red wine, chocolate, basically all yummy foods, can trigger HTN crisis.
Lithium - treats bipolar disorder
Lithium Pharmacodynamics - SE: GI upset, fine hand tremors (expected,) coarse
hand tremors (toxicity,) polyuria, kidney toxicity, electrolyte imbalances (Na)
Toxicity: Over 1.5, monitor lithium and sodium levels
Symptoms of Toxicity: Coarse tremors, hypotension, seizures, tinnitus, coma,
death
No diuretics, eat enough salt, no NSAIDs, no anticholinergic meds, adequate fluid
Carbamazepine - + valproic avid
treats: BPD, seizures
Carbamazepine pharmacodynamics - SE of Carbamazepine: blood levels down:
leukopenia, thrombocytopenia, nystagmus, hypoosmolality, rash
SE of Valproic acid: hepatoxicity
First gen antipsychotics - First Generation (Conventional): Control positive side
effects.
Chlorpromazine, haloperidol - dopamine antagonists
Treat Psychotic disorders such as schizophrenia
First Gen Pharmacodynamics - EPS: Dystonia: spasm of neck, face, back, tongue
Parkinson symptoms: drooling, shuffling, tremors
Akathisia: inability to sit still
Tardive dyskinesia: involuntary movement of tongue and face
Neuroleptic malignant syndrome: fever, dysrhythmia, muscle rigidity
VIA: IM injections every 2-4 weeks
EPS: anticholinergic meds
second generation antipsychotics - Risperidone, clozapine
treats: Schizophrenia (positive and negative symptoms) [Show Less]